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Himanshu Aggarwal, a urogynaecologist from Alabama, joined fellow medics to write a book to teach surgeons how to use time honoured native tissue repairs for women's pelvic floor problems, so they do not rely on mesh implants

The worry comes amid a growing tide of concern that the implants have been aggressively marketed in the last 20 years which has left new surgeons not getting enough experience of alternative operations.

In the UK this month a study carried out in three centres - Leicester, Newcastle and Galway in Ireland - said many surgeons choose mesh as they don’t have the skills to do traditional alternatives.

In Germany surgeons Dimitri Barski and Thomas Otto said of the pelvic floor implants: “The future of surgical care depends on the research we do now.

Meanwhile, in America, surgeon Himanshu Aggarwal is among a team of surgeons who this month published a book on how to carry out three alternative fixes for incontinence - Burch, slings made from a patient’s own tissue or vaginal wall suspension pioneered by Dr Philippe Zimmern.

Mr Aggarwal said: “The main reason to write the book was to disseminate the information and techniques to make the medical community aware that there are effective techniques available and we don’t need mesh.”

The synthetic implants have been used in women in hospitals globally for nearly two decades.

In the last ten years more than 92,000 mesh tapes have been implanted into women in the UK to fix incontinence.

A new survey suggests that as time goes by, the skills to carry out mesh-free traditional surgery fixes are being lost.

Some surgeons don’t choose mesh implants as a preference , it said, but because they are: “Unable to offer alternative procedures because they had not received training in procedures such as colposuspension or fascial sling.

“Patients hope and expect that doctors know what they are talking about and that treatments offered are the most suitable/effective,” the report said.

“However, it is clear that the treatments may depend largely upon the discipline and training of the surgeon,” rather than any evidence.

“This is an important finding not only for future research plans, but also as a training and clinical governance issue, bearing in mind the increasing concerns about mid urethral tape (MUT) complications, how they are managed, and the possibility of providing women with alternative choices.”

The inconsistency of surgeon responses will generate “considerable concern”among patients, the report adds.

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